Urgent action needed to stop spread of deadly CRE

Up to one-half of patients die from carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections, and during the first half of 2012, CDC reported that nearly 200 hospitals and long-term acute care facilities treated at least one patient infected with these bacteria.

In a Vital Signs report published last week, CDC issued an urgent call to action to the entire health care community to protect patients from CRE. According to the agency, the family of bacteria has become increasingly resistant to last-resort antibiotics during the previous decade and a greater number of hospitalized patients are getting lethal infections that are sometimes impossible to cure.

“CRE are nightmare bacteria. Our strongest antibiotics don’t work, and patients are left with potentially untreatable infections,” said CDC Director Tom Frieden, MD, MPH, in a news release. “Doctors, hospital leaders, and public health must work together now to implement CDC’s 'detect and protect' strategy and stop these infections from spreading,” he added.

Currently, almost all CRE infections occur in patients receiving medical care in hospitals, long-term acute care facilities, or nursing homes. CRE bacteria often are spread as a result of being "on the hands" of health care personnel, CDC reported, and the bacteria can transfer their resistance to other bacteria within their family. "This type of spread can create additional life-threatening infections for patients in hospitals and potentially for otherwise healthy people," the agency stated.

More than 70 bacteria, including Klebsiella pneumoniae and Escherichia coli, are part of the Enterobacteriaceae family, and they typically reside in the digestive system. These bacteria have become increasingly resistant to carbapenems, which often are referred to as last-resort antibiotics. CDC tracks CRE, and during the last decade, one type of CRE has been tracked from a single health care facility to facilities in at least 42 states. The greatest number of cases of CRE are reported in northeastern states.

Although CRE bacteria are not common nationally, the percentage of Enterobacteriaceae that are CRE increased by fourfold in the previous decade. A resistant form of K.pneumoniae (one type of CRE) has shown a sevenfold increase in the past decade.

In 2012, CDC released a CRE prevention toolkit that included recommendations such as enforcing use of infection control precautions (standard and contact precautions), grouping together patients with CRE, and having facilities alert each other when patients with CRE transition back and forth.

CDC also recommends screening patients in certain scenarios to determine whether they have been infected with CRE. "Because of the way CRE can be carried by patients from one health care setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs," the agency advised.

CDC further noted the importance of advancing research and technology, such as a testing approach called advanced molecular detection, in order to further prevent and more quickly identify CRE.